Stomach Cancer

Stomach cancer is the number seven most common cancer among males in Malaysia, and the tenth for women. Dr Gurunathan says yet many Malaysians are still unaware of its symptoms.

This is because they often dismiss them as a normal stomach ache caused by irregular eating hours or poor eating habits.

He says those at Stage 1 or Stage 2 of stomach cancer may experience the following symptoms, which are not too different from normal stomach pain:

- Indigestion or stomach discomfort
- A bloated sensation, particularly after eating
- Early satiety, where a person feels full after eating only a small amount of food
- Heartburn
- Mild nausea

However, he says, many experience very few of these symptoms in the early stages. The symptoms in the later stages of the cancer are more obvious, such as blackish stool, which indicate bleeding in the stomach, weight loss, appetite loss, lethargy, frequent vomiting or vomiting blood.

“Sadly, these extreme symptoms are the ones that finally forces patients to go to the hospital to seek treatment,” says Dr Ragunathan. “By then, it may be too late.”

H. Pylori infection

The exact cause of stomach cancer is unknown, but some factors can increase the risk of getting the cancer.

Studies have found the presence of the bacteria Helicobacter Pylori, or H. Pylori, in 70-90 per cent of the patients with stomach cancer.

These bacteria can act as a carcinogen that can eventually lead to stomach cancer, says Dr Ragunathan. However, not everyone infected will end up with cancer.

He notes an interesting finding of a research in Malaysia which shows more Indians infected with H. Pylori compared with the Chinese, yet more Chinese suffer from stomach cancer.

Dr Ragunathan says the early symptoms of H. Pylori infection are almost similar to that of stomach cancer, and sometimes patients are treated using over-the-counter medication.

“But if you have recurrent attacks of symptoms despite being on medication, you need to go to a hospital and get yourself checked,” he says.

A routine blood test can determine if one is infected by H. Pylori. Treatment can be as simple as a week’s dosage of antibiotics, he says.

Will there be recurrent infections? Probably, says the doctor, but chances are very slim.

Genetics

Studies show ethnicity and genetics also seem to play quite a significant part in determining who is more pre-disposed to getting the cancer.

Statistics by the National Cancer Institute in 2006 reveal that the Chinese make up 61.7 per cent of stomach cancer patients, followed by the Malays (25.9 per cent) and Indians (12.4 per cent).

“We have tried to find a correlation between the types of diet exclusive to an ethnic group and other possible factors, but due to the melting pot that is Malaysia, the results were rather inconclusive,” he says.

Lay off raw food

Interestingly, prolonged ingestion of raw foods can increase the risk of getting the cancer. This finding disputes the belief of some health advocates, which advocates raw food as the healthier alternative to cooked foods.

“Raw foods have been cited as one of the reasons why Japan has higher incidences of stomach cancer,” says Dr Ragunathan.

“I’m not saying you can’t eat sushi at all, but perhaps it can be limited to once a month.”

Besides that, a diet of salt-cured, smoked, pickled or preserved foods, which are very common in countries like China, Korea and Japan, have also been associated with an increased risk of stomach cancer.

Obesity, aging and bad habits such as cigarette smoking and regular alcohol consumption are also cited as contributing factors for stomach cancer.

In Japan, where the incidence of stomach cancer is very high, mass screening is carried out for anyone above 40.

“However, it is not feasible in Malaysia because incidences aren’t as high as Japan’s and will not be as cost-effective,” says Dr Ragunathan.

Diagnosing and Treatment

He says detecting stomach cancer can be done through an endoscopy. This is where a tube with a video lense at its tip is inserted into the stomach cavity via the mouth.

The endoscopist can examine the entire stomach wall visually and take tissue samples of suspicious areas to determine the presence of cancer cells, if any.

He says in government hospitals, endoscopies can be done at the heavily-subsidised price of RM20.

However, he says, sometimes doctors are keen to treat with just medication alone.

Therefore, he says, if a patient is over 45, has family history of stomach cancer and has been suffering of the symptoms for some time, they should relay this to the doctor and ask: “Should I have an endoscopy done?”

If stomach cancer is detected while it is still at stage 1, surgery may not even be required to remove the tumour, says Dr Ragunathan.

“It can be removed through endoscopy, and for stage 2, a surgery called gastractomy may be required,” he says.

The procedure involves removing from half to the entire stomach, depending on the location of the tumour. This may be followed by chemotherapy or radiotherapy.

Can a person live without his stomach? Surprisingly, the doctor says yes.

“They can still enjoy a reasonably good life. The only problem is that they may have to eat six or seven small meals instead of two or three large meals as there is no place - or for those who have their stomachs partially removed - limited space to hold the food,” he says.

However, stage 3 and 4 may be more difficult to treat, he says.

“Treatment would be more to palliative care, radiotherapy and chemotherapy.

So do your screening early if you suspect something amiss. It can be treated if detected early enough.”

Dr Gurunathan is the organising chairman for the two day Congress begining Nov 10 organised by The Malaysian Upper Gastrointestinal Surgical Club and the College of Surgeons.

Well known foreign and local specialists attended and spoke at the Congress, which discussed topics pertaining to upper gastro intestinal surgery, a fairly new and rapidly progressing subspeciality in Malaysia